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PubMed1992

Three diagnostic systems for autism: DSM-III, DSM-III-R, and ICD-10.

ICD-10 draft research criteria for childhood autism were applied to a previously published data set comparing DSM-III and DSM-III-R to clinicians' diagnoses of autism. The ICD-10 approach paralleled clinicians' patterns of diagnosis and, to a lesser extent, the DSM-III system. Relative to either clinicians, DSM-III, or ICD-10 the DSM-III-R system overdiagnosed the presence of autism. Implications for research and for future revision of diagnostic criteria are discussed.

Adolescent↗
PubMedDate not supplied

DSM-III and DSM-III-R schizotypal symptoms in borderline personality disorder.

The frequency of DSM-III and DSM-III-R schizotypal personality disorder (SPD) symptoms and diagnosis was explored in 39 inpatients classified as borderline by the Diagnostic Interview for Borderlines (DIB) and 19 inpatient major depressive disorder (MDD) controls. Most SPD symptoms in all groups, except the nondepressed borderlines, derived from social-interpersonal items. By DSM-III, 24 borderlines (62%) but only six controls (32%) had cognitive-perceptual SPD symptoms (P = .03), whereas by DSM-III-R only 14 borderlines (36%) and seven controls (37%) had such symptoms. Of the 24 borderlines showing cognitive-perceptual symptoms, 16 also had MDD, a significant difference from the non-MDD borderlines (P = .04). This difference disappears in DSM-III-R. The results suggest that some SPD symptoms in borderlines may be related to a concurrent affective episode.

Adult↗
PubMed1991

International use and attitudes toward DSM-III and DSM-III-R: growing consensus in psychiatric classification.

A survey of the uses and attitudes of 146 mental health professionals, primarily psychiatrists and psychologists, in 42 countries (not including the United States) toward the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and its revision (DSM-III-R; American Psychiatric Association, 1980,1987) is reported. The results revealed wide-spread endorsement of the multiaxial system, theoretical neutrality, descriptive symptom criteria forming discrete categories, and the placement of personality disorders on a separate axis. We report that the DSM-III and DSM-III-R are more widely used around the world than the International Classification of Diseases for teaching, research, and clinical practice. Opinions about various dimensions of the DSM's usefulness and shortcomings are presented.

Attitude of Health Personnel↗
PubMed1994

Clinical diagnoses in 216 insomnia patients using the International Classification of Sleep Disorders (ICSD), DSM-IV and ICD-10 categories: a report from the APA/NIMH DSM-IV Field Trial.

Three diagnostic classifications for sleep disorders have been developed recently: the International Classification of Sleep Disorders (ICSD), the Diagnostic and Statistical Manual, 4th edition (DSM-IV), and the International Classification of Diseases, 10th edition (ICD-10). No data have yet been published regarding the frequency of specific diagnoses within these systems or how the diagnostic systems relate to each other. To address these issues, we examined clinical sleep disorder diagnoses (without polysomnography) in 257 patients (216 insomnia patients and 41 medical/psychiatric patients) evaluated at five sleep centers. A sleep specialist interviewed each patient and assigned clinical diagnoses using ICSD, DSM-IV and ICD-10 classifications. "Sleep disorder associated with mood disorder" was the most frequent ICSD primary diagnosis (32.3% of cases), followed by "Psychophysiological insomnia" (12.5% of cases). The most frequent DSM-IV primary diagnoses were "Insomnia related to another mental disorder" (44% of cases) and "Primary insomnia" (20.2% of cases), and the most frequent ICD-10 diagnoses were "Insomnia due to emotional causes" (61.9% of cases) and "Insomnia of organic origin" (8.9% of cases). When primary and secondary diagnoses were considered, insomnia related to psychiatric disorders was diagnosed in over 75% of patients. The more narrowly defined ICSD diagnoses nested logically within the broader DSM-IV and ICD-10 categories. We found substantial site-related differences in diagnostic patterns. These results confirm the importance of psychiatric and behavioral factors in clinicians' assessments of insomnia patients across all three diagnostic systems. ICSD and DSM-IV sleep disorder diagnoses have similar patterns of use by experienced clinicians.

Adolescent↗
PubMed1999

A pilot controlled family study of DSM-III-R and DSM-IV ADHD in African-American children.

BACKGROUND: Very little is known about attention-deficit hyperactivity disorder (ADHD) in African-American children, and although the familial transmission of ADHD has been well established in white samples, prior work has not evaluated this feature of ADHD in African-American families. METHOD: Subjects were 37 first-degree relatives of children with DSM-III-R-defined ADHD and 52 first-degree relatives of non-ADHD comparison children matched for ethnicity, age, and gender. DSM-III-R-based structured interviews (modified to include DSM-IV diagnoses) provided the basis for psychiatric diagnoses in relatives. RESULTS: The risks for both DSM-III-R and DSM-IV ADHD were significantly greater in first-degree relatives of ADHD probands than in relatives of controls. In addition, the relatives of ADHD probands also were at higher risk for oppositional defiant disorder, antisocial personality disorder, major depression, generalized anxiety, and substance use disorders. CONCLUSIONS: These results suggest that ADHD and related disorders are familial in African-Americans. Further work is needed to confirm the familial transmission of ADHD in African-American children and to explore the role of genetics as well as environmental factors in the transmission of the disorder.

Adolescent↗
PubMed1988

DSM-III and DSM-III-R diagnoses of autism.

The authors examined the reliability, sensitivity, and specificity of DSM-III and DSM-III-R criteria for autism in relation to each other and to clinical diagnoses in 114 children and adults (52 diagnosed by clinicians' best judgment as autistic and 62 as nonautistic but developmentally disordered). They used a standard, structured coding scheme to evaluate each patient. The reliability of specific criteria was generally high. Although DSM-III criteria were highly specific, they were less sensitive; the reverse was true for DSM-III-R. The authors conclude that the diagnostic concept of autism in DSM-III-R appears to have been substantially broadened.

Adolescent↗
PubMed1988

A comparison of DSM-III and DSM-III-R schizophrenia.

The authors compared DSM-III and DSM-III-R definitions of schizophrenia among 532 inpatients treated in a long-term residential setting and reevaluated an average of 15 years later. Largely by excluding those with nonbizarre delusions (somatic, grandiose, or religious) without hallucinations, DSM-III-R reduced the number of patients diagnosed with schizophrenia by 10%. With the exception of the sign and symptom variables used to define them, the DSM-III schizophrenic patients included (N = 164) and excluded (N = 18) by DSM-III-R did not differ with respect to demographic, premorbid, or long-term outcome characteristics. The authors argue that frequent changes in diagnostic schemes in the absence of evidence of improved validity are likely to impede progress in research.

Adult↗
PubMed1989

Melancholia: from DSM-III to DSM-III-R.

On July 26, 1985, an ad hoc committee appointed by the APA Work Group to Revise DSM-III met and reviewed the research on the validity of the DSM-III criteria for melancholia. In this paper the proceedings of the meeting are related. After reviewing studies of the validity of the DSM-III melancholia criteria, the authors describe the committee's discussion of alternative proposals for DSM-III-R and the process of developing the new DSM-III-R criteria.

Depressive Disorder↗
PubMed1994

Usefulness of DSM-III axis III in psychiatric inpatients: an actuarial comparison with the DSM-II period.

This study is a retrospective evaluation of the usefulness of DSM-III axis III (physical disorders) and its ability to enhance clinical case description in general psychiatric patients. The subjects of this study consisted of two samples of 75 inpatients; each was randomly selected and age-matched to represent DSM-II (1975-1979) and DSM-III (1981-1985) periods, respectively. The results indicated a substantial and statistically significant difference in the frequency of physical disorders recorded at intake before (9.3%) and after (46.7%) the implementation of DSM-III. DSM-III axis III may significantly enhance the recording of physical disorders in psychiatric inpatients.

Adult↗
PubMed1994

Diagnostic concordance for DSM-IV sleep disorders: a report from the APA/NIMH DSM-IV field trial.

OBJECTIVE: The frequency and ranking of DSM-IV sleep disorder diagnoses of clinical patients with complaints of insomnia, as well as rates of diagnostic agreement and disagreement between two types of interviewers, were investigated. METHOD: Interviewers at five clinical sites assessed 216 patients referred for insomnia complaints. One sleep specialist and one general clinician interviewed each patient in an unstructured clinical interview, assigned DSM-IV diagnoses, and indicated their reactions to the diagnostic system. RESULTS: Insomnia due to another mental disorder was the most frequent DSM-IV diagnosis across sites, followed by primary insomnia. Interviewers at the five sites differed significantly in the rankings they assigned to different diagnoses. In addition, sleep specialists at most sites diagnosed psychiatric forms of insomnia more frequently than nonspecialists. Kappa values for agreement between the two types of clinicians on multiple DSM-IV sleep diagnoses ranged from 0.26 to 0.80 across sites, indicating moderate agreement overall. Kappa values for individual diagnoses varied across sites and specific diagnoses and ranged from poor to excellent. Interviewers' ratings of their confidence in diagnoses and the fit and ease of use of the DSM-IV categories also showed significant variability related to site and type of interviewer. CONCLUSIONS: The distribution of diagnoses highlights the importance of psychiatric and behavioral factors in the assessment of insomnia. Site-related variability indicates a need for greater standardization in the application of sleep disorder diagnostic criteria. Diagnostic concordance for these diagnoses, while only moderately good, likely reflects actual clinical practice and would be improved through the use of standardized (or structured) interviews and increased training.

Adult↗
PubMed1991

Characterization of DSM-III-R criteria for uncomplicated alcohol withdrawal provides an empirical basis for DSM-IV.

The DSM-III-R criteria for uncomplicated alcohol withdrawal require the presence of coarse tremor of the hands, tongue, or eyelids plus one of a number of other clinical features. We examined the validity and other characteristics of these items in 137 patients in pure alcohol withdrawal using the reliable and valid Clinical Institute Withdrawal Assessment for Alcohol. The DSM-III-R items of hand tremor amplitude, nausea or vomiting, headache, transient hallucinations, autonomic hyperactivity (increased pulse or sweating), and anxiety correlated significantly with total score and significantly indicated clinical severity. Addition of an "agitation" item improved the correlation. The diagnostic accuracy is greater than 95% if any two or more items are present. The number of positive items, of which tremor can be one, to grade clinical severity shows that a score of 2 indicates "very mild"; 3, "mild"; 4, "moderate"; and 5, "severe.". We propose that an Alcohol Withdrawal Diagnostic Inventory and a DSM-III-R-compatible brief Clinical Institute Withdrawal Assessment for Alcohol are useful for clinical research, where graded symptom characterization is needed. Our data may be helpful in the development of criteria for DSM-IV.

Adult↗
PubMed2004

The co-occurrence of DSM-IV alcohol abuse in DSM-IV alcohol dependence: results of the National Epidemiologic Survey on Alcohol and Related Conditions on heterogeneity that differ by population subgroup.

BACKGROUND: In DSM-IV, an alcohol abuse diagnosis is preempted by dependence, although the symptoms of each disorder are different. Consequently, little is known about the extent to which dependence occurs with or without abuse. The distinction is important because of potential heterogeneity in dependence as a phenotype in genetic research, as well as potential underestimation of alcohol dependence when surveys cover dependence symptoms only among those who screen positive for alcohol abuse. OBJECTIVE: To present the prevalence of DSM-IV alcohol dependence with and without alcohol abuse in national and population subgroups. DESIGN: Face-to-face interviews. SETTING: The United States, including Alaska, Hawaii, and the District of Columbia. PARTICIPANTS: Household and group-quarters residents, 18 years and older, in the National Epidemiologic Survey on Alcohol and Related Conditions (N = 42 392). MAIN OUTCOME MEASURES: DSM-IV alcohol dependence with and without DSM-IV alcohol abuse, assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule. RESULTS: Among respondents with current alcohol dependence, 33.7% did not additionally meet criteria for abuse (29.0% among men and 46.1% among women). Current dependence without abuse was especially common among minority women (48.5% among African Americans, 55.2% among Hispanics). Among respondents with lifetime diagnoses of dependence, 13.9% did not additionally meet criteria for abuse (10.1% among men, 22.1% among women): proportions were highest among minorities, eg, 29.1% among Hispanic women and 19.2% among Hispanic men. CONCLUSIONS: Alcohol abuse does not always accompany alcohol dependence in the general population, especially among women and minorities. Dependence with and without abuse may represent heterogeneous phenotypes for genetic research. Use of alcohol abuse as a screening method for alcohol dependence in large epidemiologic studies will differentially underestimate the prevalence of dependence by subgroup, affecting time trend and comorbidity research. Such underestimation may also perpetuate a lack of services for traditionally underserved groups.

Adolescent↗
PubMed1995

DSM-III, DSM-IV and ICD-10 as severity scales for drug dependence.

The construct of illness severity serves many scientific and clinical functions. This study tested the performance as severity scales of three systems for diagnosing drug dependence--DSM-III, DSM-IV and ICD-10--in a multisite regional sample of 370 clinical subjects. Both lifetime and current severity of four drug problems--alcohol, cannabis, cocaine and opiate dependence--was studied in three stages: (a) item difficulty and internal consistency analysis; (b) probabilistic modeling of distribution behavior; and (c) concurrent validation against a set of independent measures. All three systems, for most drugs correlated with most test variables, had good to excellent concurrent validity. Unexpectedly, DSM-III showed in some instances better item behavior, composite score behavior and concurrent validity than the other systems, though DSM-IV and ICD-10 are based on slimmer generic algorithms, and may represent a good balance between simplicity and concurrent validity. Results suggest that the design of future diagnostic algorithms start at the item level and strive for moderate levels of both internal consistency and difficulty. Composite score distributions can then be modeled in field research, and necessary item corrections can be made before the algorithm is widely promulgated.

Adult↗
PubMed1997

Diagnosing DSM-IV--Part I: DSM-IV and the concept of disorder.

In this first article in a two-article series, I diagnose' a problem with DSM-IV, specifically, the overinclusiveness of its diagnostic criteria. Using the harmful dysfunction analysis of the concept of disorder (Wakefield, 1992a, American Psychologist, 47, 373-388) as a framework, I argue that DSM-IV criteria for many diagnostic categories fail to satisfy the analysis' dysfunction' requirement, that is, the criteria do not distinguish harmful conditions due to internal dysfunctions from harmful conditions that are nondisordered 'problems in living'. The overinclusiveness problem, I suggest, can be partly dealt with by giving up purely symptomatic criteria and contextualizing diagnosis to take into account the relationship between triggering causes and resulting symptoms. In Part II (Wakefield, 1997, Behaviour Research and Therapy, 35, 651-665, I examine Eysenck's (1986, Contemporary directions in psychopathology: Toward the DSM-IV) proposal for a dimensional diagnostic system to supplant DSM-IV.

Humans↗
PubMedDate not supplied

Symptoms of prototypic patients with passive-aggressive personality disorder: DSM-IIIR versus DSM-IV negativistic.

This study examined features of patients that clinicians identified as good examples of Passive-Aggressive Personality Disorder to identify core features of the disorder and to determine which set of criteria (DSM-III-R, two definitions in the DSM-IV Options Book, or DSM-IV Negativistic) best characterized the identified patients. A national sample of licensed psychologists (N = 68) identified a patient who (based on symptoms) was a good example of Passive-Aggressive Personality Disorder. They then rated the patient on a symptom checklist composed of the Passive-Aggressive and Negativistic criteria, as well as other personality-disorder symptoms that overlap with Passive-Aggressive. Clinicians identified patients they considered exemplars for Passive-Aggressive Personality Disorder, and there was moderate consensus about their characteristic symptoms. DSM-III-R symptoms received the highest ratings, and there was little overlap with other personality disorders. Principal-component factor analysis suggested that a general pattern of passive resistance, along with a behavioral manifestation of procrastination and a second group of symptoms suggesting interpersonal difficulties, were the features of these passive-aggressive patients. More male patients were identified as good examples of the disorder, and female patients presented a more heterogeneous diagnostic picture. Implications and directions for future research are discussed, including the need to integrate research findings from the differing perspectives on personality disorders.

Adult↗
PubMed1994

A comparison of DSM-III-R, DSM-IV and ICD-10 substance use disorders diagnoses in 1922 men and women subjects in the COGA study. Collaborative Study on the Genetics of Alcoholism.

A research interview was used to evaluate the relationships between DSM-IV, DSM-III-R and ICD-10 diagnostic criteria for substance use disorders. The sample of 1992 subjects, including both men and women, was composed of subjects and their relatives from the Collaborative Study on the Genetics of Alcoholism (COGA) study. With regard to diagnoses of substance dependence, the analyses revealed tha the proportions of individuals diagnosed in the three systems were similar, with the highest numbers observed for DSM-III-R, the lowest for ICD-10 and the figures for DSM-IV between the two. The kappas for dependence diagnoses ranged from 0.54 to 0.83, with the majority at 0.7 and higher, indicating that the same subjects were being given the same labels in the three systems. However, the criteria for abuse or harmful use resulted in rather disparate proportions labeled across the three systems, with kappas that rarely exceeded 0.10.

Adult↗
PubMed1988

DSM-III, draft DSM-III-R, and the diagnosis and prevalence of bulimia in Australia.

A self-report questionnaire for bulimic symptoms was administered to three different groups of community residents and to patients in a hospital's weight disorders unit and its dietetics department. The prevalence of DSM-III bulimia was 12.7% among female community residents, while the prevalence of draft DSM-III-R bulimia was 1.7%. The questionnaire, scored to reflect DSM-III, categorized as bulimic large numbers of patients who were not given that diagnosis by clinicians. The draft DSM-III-R criteria seemed more closely aligned to clinical experience.

Australia↗
PubMed1991

Subtyping DSM-III-R primary insomnia: a literature review by the DSM-IV Work Group on Sleep Disorders.

OBJECTIVE: The authors review the usefulness, reliability, and validity of recently proposed subtypes of primary insomnia. DSM-III uses "primary insomnia" to indicate chronic insomnia not associated with other diagnosable mental or medical disorders, whereas the International Classification of Sleep Disorders (ICSD) recognizes three subtypes: psychophysiological insomnia, idiopathic insomnia, and sleep state misperception. METHOD: After reviewing all of the primary source references for each insomnia disorder in the ICSD and all of the additional primary sources cited in each of these, the authors conducted an automated literature search using Medline. Of the 48 primary sources located, the authors selected 27 studies that were reported in peer-reviewed journals, had the largest available subject groups, used diagnostic reliability procedures, and included control groups. RESULTS: The studies reviewed contained limited empirical support for the proposed distinction between idiopathic and psychophysiological insomnia. Sleep state misperception appears, however, to be a highly prevalent feature of chronic insomnia generally, rather than only a specific disorder per se. CONCLUSIONS: The authors conclude that there is not yet sufficient empirical evidence to warrant the abandonment of DSM-III-R "primary insomnia" and the adoption of the ICSD subtypes in DSM-IV. However, they affirm the heuristic value of the ICSD subtypes and the need for field trials to compare the performance characteristics of the DSM-III-R and ICSD systems with respect to 1) interrater reliability, 2) effects of rater expertise (generalist versus specialist) on rates of agreement, and 3) effects of polysomnographic data on rates of agreement.

Humans↗